Granello suggests there is a two-tiered clinical approach when treating suicidal clients. They are _______ and _______.

• A. Assessment and safety planning
• B. Stabilization and address underlying factors
• C. Risk management and cognitive restructuring
• D. Crisis intervention and family therapy

Answer: (C)

Granello’s two-tiered approach to treating suicidal clients centers on risk management and cognitive restructuring. The first tier, risk management, focuses on immediate safety: assessing the level of risk, creating and enforcing a safety plan, reducing access to means, and coordinating crisis or emergency resources to prevent imminent self-harm. The second tier targets the thoughts and beliefs that maintain suicidality through cognitive restructuring—identifying and challenging negative automatic thoughts, hopelessness, and beliefs about being a burden, and replacing them with more accurate interpretations and adaptive coping strategies. This combination allows the clinician to keep the client safe in the short term while also working on the cognitive processes that underlie ongoing suicidality, leading to longer-term change.

Other options emphasize aspects that are not the two-tiered framework Granello describes, such as focusing primarily on safety planning without the explicit cognitive change component, or pairing stabilization or family therapy with crisis work, which shifts the emphasis away from the specific risk-management plus cognitive-behavioral change pairing.